Provider Demographics
NPI:1578581658
Name:DELGADO, JOSE A (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:A
Last Name:DELGADO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1295 PEORIA ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61571-2352
Mailing Address - Country:US
Mailing Address - Phone:309-444-5800
Mailing Address - Fax:309-444-5803
Practice Address - Street 1:1295 PEORIA ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IL
Practice Address - Zip Code:61571-2352
Practice Address - Country:US
Practice Address - Phone:309-444-5800
Practice Address - Fax:309-444-5803
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-009418111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00063210OtherRAILROAD MEDICARE
IL09028085OtherBLUE CROSS & BLUE SHIELD
IL038009418Medicaid
ILU87098Medicare UPIN
IL977320Medicare PIN